From the Neurology Unit (A. Pilotto, A.S., B.B., A.L., A. Padovani), Department of Clinical and Experimental Sciences, and Neuroradiology Unit (R.G.), Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia; Parkinson's Disease Rehabilitation Centre (A. Pilotto, M.C.R.), FERB ONLUS-S. Isidoro Hospital, Trescore Balneario, Bergamo; Department of Neuroscience "Rita Levi Montalcini" (A.R., E.M., L.L.) and Autonomic Unit (S.M.), Department of Medical Sciences, University of Turin, Italy; Department of Medicine (Neurology) (M.M., C.O.-L., S.E.B.), University of Toronto; Hurvitz Brain Sciences Program (M.M., C.O.-L., S.E.B.), Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Neurology (Y.S., R.T., K.Y., T.H., N.H.), Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Neuroscience Imaging and Clinical Sciences (L.B., S.D.P.), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Department of Medicine and Neuroscience and Mental Health Institute (R.C., M.G.), University of Alberta, Edmonton, Canada; Department of Radiology (L.L.W.), and Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E.), Department of Neurology, University of Cincinnati, OH; Department of Molecular and Translational Medicine (A.K.D.), Texas Tech University Health Sciences Center, El Paso; Parkinson and Other Movement Disorders Center (K.L., I.L.), Department of Neurosciences, University of California, San Diego, La Jolla; Department of Neurology (F.R.-P.), Medical University of South Carolina, Charleston; Imaging Research Center (M.D), Department of Radiology, Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine (M.D.), OH; Department of Neurology (J.A.V.), Emory University, Atlanta, GA; ASST Spedali Civili Hospital (R.G.), Brescia, Italy; and Department of Neurology (A.M.), The Ohio State University, Columbus .
Neurology. 2021 Aug 24;97(8):e814-e824. doi: 10.1212/WNL.0000000000012342. Epub 2021 Jun 7.
To evaluate whether orthostatic hypotension (OH) or supine hypertension (SH) is associated with brain atrophy and white matter hyperintensities (WMH), we analyzed clinical and radiologic data from a large multicenter consortium of patients with Parkinson disease (PD) and dementia with Lewy bodies (DLB).
Supine and orthostatic blood pressure (BP) and structural MRI data were extracted from patients with PD and DLB evaluated at 8 tertiary-referral centers in the United States, Canada, Italy, and Japan. OH was defined as a systolic/diastolic BP fall ≥20/10 mm Hg within 3 minutes of standing from the supine position (severe ≥30/15 mm Hg) and SH as a BP ≥140/90 mm Hg with normal sitting BP. Diagnosis-, age-, sex-, and disease duration-adjusted differences in global and regional cerebral atrophy and WMH were appraised with validated semiquantitative rating scales.
A total of 384 patients (310 with PD, 74 with DLB) met eligibility criteria, of whom 44.3% (n = 170) had OH, including 24.7% (n = 42) with severe OH and 41.7% (n = 71) with SH. OH was associated with global brain atrophy ( = 0.004) and regional atrophy involving the anterior-temporal ( = 0.001) and mediotemporal ( = 0.001) regions, greater in severe vs nonsevere OH ( = 0.001). The WMH burden was similar in those with and without OH ( = 0.49). SH was not associated with brain atrophy ( = 0.59) or WMH ( = 0.72).
OH, but not SH, was associated with cerebral atrophy in Lewy body disorders, with prominent temporal region involvement. Neither OH nor SH was associated with WMH.
为了评估直立性低血压（OH）或仰卧位高血压（SH）是否与脑萎缩和白质高信号（WMH）相关，我们分析了来自帕金森病（PD）和路易体痴呆（DLB）患者的大型多中心联盟的临床和影像学数据。
从美国、加拿大、意大利和日本的 8 个三级转诊中心评估的 PD 和 DLB 患者中提取仰卧位和直立位血压（BP）和结构 MRI 数据。OH 定义为从仰卧位站立 3 分钟内收缩压/舒张压下降≥20/10mmHg（严重者≥30/15mmHg），SH 定义为 BP≥140/90mmHg，而坐姿 BP 正常。使用经过验证的半定量评分量表评估诊断、年龄、性别和疾病持续时间调整后的全球和区域性脑萎缩和 WMH 差异。
共有 384 名患者（310 名 PD，74 名 DLB）符合入选标准，其中 44.3%（n=170）有 OH，包括 24.7%（n=42）严重 OH 和 41.7%（n=71）SH。OH 与全脑萎缩相关（ = 0.004）和涉及前颞（ = 0.001）和中颞（ = 0.001）区域的区域性萎缩，严重 OH 比非严重 OH 更严重（ = 0.001）。有和没有 OH 的患者的 WMH 负担相似（ = 0.49）。SH 与脑萎缩（ = 0.59）或 WMH（ = 0.72）无关。
在路易体疾病中，OH 与脑萎缩相关，尤其是颞叶区域受累，但 SH 与脑萎缩或 WMH 无关。
